臨床上,，肺癌晚期患者出現(xiàn)局限轉移灶后，醫(yī)生往往采用外科手術直接切除腫瘤組織的辦法治療癌癥患者,。但這一做法并不能有效地遏制癌癥患者病情的發(fā)展,，為了控制腫瘤的復發(fā)，臨床醫(yī)生們經(jīng)常采用放射治療（放療）的方法以希望降低患者腫瘤復發(fā)的風險,。
但近來,，一項刊登在Cancer雜志上的研究表明：放射治療應該有針對性的開展，因為放療并不能延長肺癌老年患者的存活時間,。對那些已經(jīng)接受外科切除手術治療的肺癌晚期患者,，常規(guī)的放射治療應該慎重。
來自美國紐約西奈山醫(yī)學院的研究人員開展的這項研究充分分析了放射治療是否能延長肺癌患者的生存時間,。
研究者調查分析了1992年至2005年間,，共1,307例肺癌晚期病例。研究人員發(fā)現(xiàn)：在這1,307例肺癌晚期病患中,，有710位病人（約占總人數(shù)的54％）在接受完外科手術治療后又進行了放射治療,，但數(shù)據(jù)表明這些人的存活時間比那些沒有接受放射治療的患者并沒有顯著延長。
研究人員強調：在我們確定是否要對肺癌患者進行放射治療之前,，我們應該認真考慮放療是否能延長患者存活時間,，放療是否會給患者帶來潛在好處,。(生物谷 Bioon.com)
doi:10.1002/cncr.26585
PMC:
PMID:
Postoperative radiotherapy for elderly patients with stage III lung cancer
Juan P. Wisnivesky MD, DrPh1,2,*, Ethan A. Halm MD, MPH3,4, Marcelo Bonomi MD5,6, Cardinale Smith MD5,6, Grace Mhango MPH1, Emilia Bagiella PhD7
BACKGROUND:
The potential role of postoperative radiation therapy (PORT) for patients who have completely resected, stage III nonsmall cell lung cancer (NSCLC) with N2 disease remains controversial. By using population-based data, the authors of this report compared the survival of a concurrent cohort of elderly patients who had N2 disease treated with and without PORT.
METHODS:
By using the Surveillance, Epidemiology, and End Results (SEER) registry linked to Medicare records, 1307 patients were identified who had stage III NSCLC with N2 lymph node involvement diagnosed between 1992 and 2005. Propensity scoring methods and instrumental variable analysis were used to compare the survival of patients who did and did not receive PORT after controlling for selection bias.
RESULTS:
Overall, 710 patients (54%) received PORT. Propensity score analysis indicated that PORT was not associated with improved survival in patients with N2 disease (hazard ratio [HR], 1.11; 95% confidence interval [CI], 0.97-1.27). Analyses that were limited to patients who did or did not receive chemotherapy, who received intermediate-complexity or high-complexity radiotherapy planning, or adjusted for time trends produced similar results. The instrumental variable estimator for the absolute improvement in 1-year and 3-year survival with PORT was ?0.04 (95% CI, ?0.15 to 0.08) and ?0.08 (95% CI, ?0.24 to 0.15), respectively.
CONCLUSIONS:
The current data suggested that PORT is not associated with improved survival for elderly patients with N2 disease. These findings have important clinical implications, because SEER data indicate that a large percentage of elderly patients currently receive PORT despite the lack of definitive evidence about its effectiveness. The potential effectiveness of PORT should be evaluated further in randomized controlled trials.
